Geographic trends in incidence of hip fractures: a comprehensive literature review

Summary A comprehensive review of literature was conducted to investigate variation in hip fracture incident rates around the world. The original crude incidence rates were standardized for age and sex for comparability. After standardization, the highest rates of hip fracture were found in Scandinavia and the lowest rates in Africa. Introduction This study was conducted to investigate the geographic trends of the incidence of osteoporotic hip fractures through a comprehensive review of literature. Methods Studies were identified for inclusion in the review by searching the MEDLINE database via PubMed and applying strict inclusion and exclusion criteria. Agespecific incidence rates were extracted from the articles, and in order to provide a common platform for analysis, we used directly age-standardized and age–sex-standardized rates (using the 2005 United Nations estimates of the world population as standard) to complete the analysis. Results Forty-six full text articles spanning 33 countries/ regions were included in the review. For ease of comparison, the results were analyzed by geographic regions: North America, Latin America, Scandinavia, Europe (excluding Scandinavia), Africa, Asia, and Australia. The highest hip fracture rates were found in Scandinavia and the lowest in Africa. We found comparable rates from countries in North America, Australia, and Europe outside of Scandinavia. The diverse makeup of the Asian continent also resulted in quite variable hip fracture rates: ranging from relatively high rates in Iran to low rates, comparable to those from Africa, in mainland China. Conclusions Given the aging of populations globally, and in the industrialized countries specifically, hip fractures will become a progressively larger public health burden. The geographic trends observed in hip fracture incidence rates can provide important clues to etiology and prevention.